Bone plate, bone plate system, and method of using the same

ABSTRACT

A bone plate comprises a plate body and at least one tab. The plate body defines an inner body surface configured to face an underlying bone, an outer body surface opposite the inner body surface, and an outer side surface that extends between the inner body surface and the outer body surface. The outer side surface defines an outer perimeter of the plate body. The at least one tab includes a head and an arm that extends from the plate body to the head. The tab defines a tab aperture that extends through the head and is configured to receive a bone anchor. The bone anchor can be coupled with a screw hole in the nail. The arm is configured to deflect with respect to the plate body so as to move the head between a pre-fixation position and a fixation position spaced from the pre-fixation position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 17/071,669filed Oct. 15, 2020, the disclosure of which is hereby incorporated byreference as if set forth in its entirety herein.

TECHNICAL FIELD

The present disclosure relates to systems, kits, assemblies, and methodsfor the placement and fixation of a bone plate against a bone forattachment to an intramedullary nail in a medullary canal of the bone.

BACKGROUND

Intramedullary nails have long been used to treat fractures in longbones of the body such as fractures in femurs, tibias, and humeri. Totreat such fractures, the intramedullary nail is inserted into amedullary canal of the long bone such that the nail extends across oneor more fractures in the long bone to segments of the long bone that areseparated by the one or more fractures. Bone anchors are then insertedthrough the bone and into the intramedullary nail on opposing sides ofthe fracture, thereby fixing the intramedullary nail to the bone. Theintramedullary nail can remain in the medullary canal at least until thefracture is fused.

The foregoing background discussion is intended solely to aid thereader. It is not intended to limit the innovations described herein.Thus, the foregoing discussion should not be taken to indicate that anyparticular element of a prior system is unsuitable for use with theinnovations described herein, nor is it intended to indicate that anyelement is essential in implementing the innovations described herein.

SUMMARY

The foregoing needs are met, to a great extent, by the system and methoddisclosed in the present application.

Retrograde femoral nailing is often used for fixation of far distalfractures of the femur. When this occurs, often in combination with poorbone quality and/or in periprosthetic settings, additional bone fixationmay be required. The proposed system links a small plate or washer tothe distal end of the nail by means of a plurality of bone screws. Inaddition, there will be a plurality of peripheral bone screws thatengage more bone than the nail's bone screws alone would, for improvedfixation. Proper placement of the washer may present difficulty withoutthe aid of an appropriate holding instrument. Attachment of a holdinginstrument may present difficulty to operating personnel, and/or theconnection may not be rigid enough.

The disclosure relates to a bone plate comprising a plate body and atleast one tab. The plate body defines an inner body surface configuredto face an underlying bone, an outer body surface opposite the innerbody surface, and an outer side surface that extends between the innerbody surface and the outer body surface. The outer side surface definesan outer perimeter of the plate body. The at least one tab includes ahead and an arm that extends from the plate body to the head. The tabdefines a tab aperture that extends through the head and is configuredto receive a bone anchor body. The arm is configured to deflect withrespect to the plate body so as to move the head between a pre-fixationposition and a fixation position spaced from the pre-fixation position.

According to another aspect of the present disclosure, a surgical kitfor securing the bone plate to a bone is provided. The surgical kitcomprises the bone plate and a bone plate adjustment tool. The boneplate adjustment tool is configured to be received within the tabaperture of the at least one tab member to transition the at least onetab member from the pre-fixation position to the fixation position.

According to another aspect of the present disclosure, a bone plateholder for holding a bone plate during a surgical procedure isdisclosed. The bone plate holder comprises a body and a shaft. The bodydefines a channel that extends through the body from a proximal surfaceof the body to a distal surface of the body. The shaft has a distal endthat includes a coupling element configured to couple the shaft to thebone plate, and the shaft further having a proximal end opposite thedistal end, wherein the proximal end includes a control elementconfigured to control the coupling element to couple to the bone plate.The shaft is configured to extend through the channel, such that thecoupling element extends out from the distal surface of the body.

This summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription section. This Summary is not intended to identify keyfeatures or essential features of the claimed subject matter, nor is itintended to be used to limit the scope of the claimed subject matter.Furthermore, the claimed subject matter is not constrained tolimitations that solve any or all disadvantages noted in any part ofthis disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofillustrative embodiments of the implant of the present application, willbe better understood when read in conjunction with the appendeddrawings. For the purposes of illustrating the implants of the presentapplication, there is shown in the drawings illustrative embodiments. Itshould be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1 illustrates a perspective view of a system according to oneaspect having a bone plate holder supported and an aiming assembly thatis attached to an intramedullary nail received in a medullary canal of abone;

FIG. 2 illustrates a top perspective view of a bone plate, according toan aspect of this disclosure;

FIG. 3 illustrates a view of a side of the bone plate shown in FIG. 2 ;

FIG. 4 illustrates a top view of the bone plate shown in FIG. 2 ;

FIG. 5 illustrates a bottom view of the bone plate shown in FIG. 2 ;

FIG. 6A illustrates a side cross-section view of the bone plate takenalong line 6A-6A in FIG. 4 ;

FIG. 6B illustrates a side cross-section view of the bone plate takenalong line 6B-6B in FIG. 4 ;

FIG. 7 illustrates a close-up top view of at least one tab member of thebone plate shown in FIG. 2 ;

FIG. 8 illustrates a perspective view of a bone plate adjustment tool,according to an aspect of this disclosure;

FIG. 9 illustrates a close-up view of a distal end of the bone plateadjustment tool shown in FIG. 8 ;

FIG. 10 illustrates a top perspective view of another aspect of a boneplate, according to an aspect of this disclosure;

FIG. 11 illustrates a view of a side of the bone plate shown in FIG. 10;

FIG. 12 illustrates a top view of the bone plate shown in FIG. 10 ;

FIG. 13 illustrates a bottom view of the bone plate shown in FIG. 10 ;

FIG. 14 illustrates a perspective view of a bone plate holder, accordingto an aspect of this disclosure;

FIG. 15 illustrates a perspective view of a body of the bone plateholder shown in FIG. 14 ;

FIG. 16 illustrates a cross-sectional view of the bone plate holdershown in FIG. 15 taken along line 16-16;

FIG. 17 illustrates a bottom view of the bone plate holder shown in FIG.14 ;

FIG. 18 illustrates a perspective view of a shaft of the bone plateholder shown in FIG. 14 ;

FIG. 19 illustrates a top view of the shaft within the body of the boneplate holder shown in FIG. 14 ;

FIG. 20 illustrates a cross-sectional view of the shaft within the bodyshown in FIG. 19 taken along line 20-20;

FIG. 21 illustrates a perspective view of an intramedullary nail that isreceived in medullary canal of a bone, the intramedullary nail coupledto a handle shown in FIG. 1 ;

FIG. 22 illustrates a perspective view of a system comprising theintramedullary nail and handle as shown in FIG. 21 with an aiming guideand the bone plate holder shown in FIG. 14 fastened to the bone plateshown in FIG. 10 ;

FIG. 23 illustrates a side view of the system of FIG. 22 with the boneplate holder supporting the bone plate and a pair of guide sleeves;

FIG. 24 illustrates a side view of the bone plate shown in FIG. 10 on abone with the bone plate adjustment tool shown in FIG. 8 inserted intoone of the tabs of the bone plate;

FIG. 25 illustrates a perspective view of the bone plate shown in FIG. 2fastened to the intramedullary nail; and

FIG. 26 illustrates a perspective view of the bone plate shown in FIG.10 fastened to the intramedullary nail.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

The present disclosure can be understood more readily by reference tothe following detailed description taken in connection with theaccompanying figures and examples, which form a part of this disclosure.It is to be understood that this disclosure is not limited to thespecific devices, methods, applications, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting of the scope of the presentdisclosure. Also, as used in the specification including the appendedclaims, the singular forms “a,” “an,” and “the” include the plural, andreference to a particular numerical value includes at least thatparticular value, unless the context clearly dictates otherwise.

Certain terminology used in this description is for convenience only andis not limiting. The words “top”, “bottom”, “distal”, “proximal”,“inward”, “outward”, “inner”, “outer”, “above”, “below”, “axial”,“transverse”, “circumferential,” and “radial” designate directions inthe drawings to which reference is made. The words “inner”, “internal”,and “interior” refer to directions towards the geometric center of theimplant and/or implant adjustment tools, while the words “outer”,“external”, and “exterior” refer to directions away from the geometriccenter of the implant and/or implant adjustment tools. The words,“anterior”, “posterior”, “superior,” “inferior,” “medial,” “lateral,”and related words and/or phrases are used to designate various positionsand orientations in the human body to which reference is made. The term“plurality”, as used herein, means more than one. When a range of valuesis expressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. Allranges are inclusive and combinable. The terminology includes theabove-listed words, derivatives thereof and words of similar import.

As used herein, the term “substantially” and derivatives thereof, andwords of similar import, when used to describe a size, shape,orientation, distance, spatial relationship, or other parameter includesthe stated size, shape, orientation, distance, spatial relationship, orother parameter, and can also include a range up to 10% more and up to10% less than the stated parameter, including 5% more and 5% less,including 3% more and 3% less, including 1% more and 1% less.

An intramedullary nail is commonly secured to bone via at least one boneanchor, where each bone anchor extends directly into the surface of thebone and into a corresponding bone-anchor aperture in the intramedullarynail such that the bone anchor attaches to both the bone and the nail.However, as forces are exerted on the intramedullary nail, theattachment or bond between the bone anchor and the bone can weaken. Thisis especially true for patients whose bone at the bone anchor site isweakened due to osteoporosis or other bone conditions. To strengthen theattachment between the bone anchor and the bone, the bone anchor can befurther secured to a bone plate that is positioned against the outersurface of the bone and secured to the bone via one or more additionalbone anchors. For example, the bone plate can be positioned against thebone, and a first bone anchor can be inserted into an aperture in theplate, through the surface of the bone, and into the intramedullarynail, such that the first bone anchor attaches to the plate, the bone,and the intramedullary nail. Further, one or more other bone anchors canbe inserted into the plate adjacent the first bone anchor such that theone or more other bone anchors terminate in the bone with or withoutpassing into the intramedullary nail. The one or more other bone anchorsprovide additional fixation to the bone that can reduce loading on thefirst bone anchor.

Referring to FIG. 1 , a system 10 is shown that is configured toposition a bone plate 100 against a surface of a bone 70 as the boneplate 100 is fastened to the bone 70 and an intramedullary nail 60. Ingeneral, the system 10 comprises a bone plate holder 400 (e.g. abone-plate placement tool) that supports the bone plate 100 andangulates the bone plate 100 so as to align a surface of the bone plate100 with a surface of the bone 70. The system further comprises a boneplate adjustment tool 200 (see FIG. 8 ) to facilitate fixation of thebone plate 100 to the bone 70.

The system 10 can further comprise one or more of the bone plates 100,at least one bone anchor 40 such as a bone screw, an aiming assembly 50,and an intramedullary nail 60. The intramedullary nail 60 is elongategenerally along a superior-inferior direction SI and is sized to bereceived in a medullary canal of a long bone such as a femur, tibia, orhumerus. The aiming assembly 50 releasably attaches to a proximal end ofthe intramedullary nail 60 and can comprise an aiming guide 80 and ahandle 90. The aiming assembly 50 can facilitate alignment of the boneplate 100 such that an axis A_(S) of the bone plate 100 is aligned withthe bone plate holder 400 and the intramedullary nail 60. For example,the axis of the bone plate 100 can be aligned with a bone-anchor openingthat extends through the intramedullary nail 60.

Referring to FIGS. 2-7 , the bone plate 100 includes a plate body 101having an inner body surface 102 (e.g. a bone-facing surface) and anouter body surface 104 opposite the bone-facing surface 102 along atransverse direction T. The body-facing surface 102 can have a curvedshape, contoured shape, or other shape configured to align with thesurface of the bone 70. The bone plate 100 includes an outer sidesurface 103 that extends about an outer perimeter of the plate body 101.The outer side surface 103 can have a first transverse side 106 and asecond transverse side 108 opposite from one another. The first andsecond transverse sides 106 and 108 can extend from the bone-facingsurface 102 to the outer body surface 104. The outer side surface 103can additionally or alternatively have a first lateral side 110 and asecond lateral side 112 opposite from one another. The first and secondlateral sides 110 and 112 can extend from the bone-facing surface 102 tothe outer body surface 104. The first and second lateral sides 110 and112 can extend from the first transverse side 106 to the secondtransverse side 108. It will be understood that embodiments of thedisclosure are not limited to the specific bone plate shown in FIGS. 2-7, and that alternative bone plates are contemplated (e.g. see bone plate300 in FIGS. 10-13 ).

The bone plate 100 defines a first bone-anchor aperture 116 configuredto be aligned with a shaft longitudinal axis A_(S1) (see FIG. 23 ) whenthe bone plate 100 is fastened to the bone-plate placement tool 400.Thus, the longitudinal axis A_(S1) can extend through the firstbone-anchor aperture 116 when the bone plate 100 is fastened to the boneplate holder 400. Further, the bone plate holder 400 is configured toalign the longitudinal axis A_(S1) with the first bone-anchor aperture116 over a full range of angles of the holder 400, without impeding witha path of a bone anchor or drill bit with the bone plate holder 400. Thefirst bone-anchor aperture 116 can extend through the bone plate 100from the outer body surface 104 to the bone-facing surface 102 so as toreceive a bone anchor 40 (FIG. 1 ) to attach the bone plate 100 to thebone 70. The first bone-anchor aperture 116 can be threaded to receive athreaded head of a bone anchor. Further, the first bone-anchor aperture116 can define variable-angle threading that permits a bone anchor to beinserted into the first bone-anchor aperture 116 at varying angles.Alternatively, the bone-anchor aperture 116 can be unthreaded.

The bone plate 100 defines at least one additional bone-anchor aperture118, such as a plurality of additional bone-anchor apertures 118. The atleast one additional bone-anchor aperture 118 is spaced from the firstbone-anchor aperture 116 such that the at least one additionalbone-anchor aperture 118 is offset from (i.e., not aligned with) theshaft longitudinal axis A_(S1) when the bone plate 100 is fastened tothe bone-plate placement tool 20. The at least one additionalbone-anchor aperture 118 extends through the bone plate 100 from theouter body surface 104 to the bone-facing surface 102. At least one ofthe bone-anchor apertures 118 can be threaded to receive a threaded headof a bone anchor. Further, each bone-anchor aperture 118 can definevariable-angle threading that permits a bone anchor to be inserted intothe bone-anchor aperture 118 at varying angles. Alternatively, eachadditional bone-anchor aperture 118 can be unthreaded.

The bone plate 100 defines at least one, such as a plurality of,bone-plate fasteners 114 configured to engage a fastener of the boneplate holder 400 so as to fasten the bone plate 100 to the holder 400.Each of the at least one bone-plate fasteners 114 can define an apertureconfigured to receive a corresponding fastener of the holder 400 so asto fasten the bone plate 100 to the holder 400. For example, eachfastener 114 can be configured to receive a projection that extends fromthe bone-plate placement tool 20. It will be understood that any othersuitable fasteners can be used to releasably fasten the bone plate 100to the bone plate holder 400. For example, the fastener 114 can comprisea fixation element 350, as further described below.

The bone plate 100 further includes at least one tab member 130. The atleast one tab member 130 extends from the outer side surface 103 of thebone plate 100. For example, the at least one tab 130 can extend fromany one the first and second transverse sides 106 and 108 and the firstand second lateral sides 110 and 112, and/or can extend from multiplesides 106, 108, 110, and 112 of the bone plate 100. For example, FIGS.2, 4, and 5 illustrate two tabs 130 that extend from the first lateralside 110, and a single tab 130 that extends from the second transverseside 108. Each of the at least one tabs 130 can extend in an outwarddirection (e.g. radial direction) from the outer side surface 103 of thebone plate 100. In an aspect, each of the at least one tabs 130 extendin a direction from the outer side surface in a direction that is offsetfrom the shaft longitudinal axis A_(S1) when the bone plate 100 isfastened to the bone-plate placement tool 20. Each of the at least onetabs 130 can extend substantially parallel to each of the other tabs130, can be angularly offset from each of the other tabs 130, orcombinations of offset and parallel (e.g. some tabs 130 are parallel toeach other, while other tabs 130 are angularly offset from other tabs130).

Each tab 130 comprises an arm 132 and a head 134. The arm 132 extendsbetween the plate body 101 of the bone plate 100 and the head 134. Thearm 132 and the head 134 can be integrally formed as a single unitarypiece. In an aspect, each tab 130 and the body 101 of the bone plate 100can be integrally formed as a single unitary piece. Alternatively, atleast one of the tabs 130 can be coupled to (e.g. attachable) to thebody 101 of the bone plate 100.

Each arm 132 can extend in an outward direction from the outer sidesurface 103 of the plate body 101. Each arm 132 can extend substantiallyperpendicular to the outer side surface 103. Alternatively, each arm 132can extend at an angle other than substantially perpendicular to theouter side surface 103. For example, with reference to FIG. 4 , each arm132 that extends from the first lateral side 110 extends in the outwarddirection at an angle of between 0 and 90 degrees. The arm 132 a thatextends from the second transverse side 108 extends in the outwarddirection at an angle of approximately 90 degrees. Each arm 132 can alsoextend in an inward or outward direction from the plate body 101. Forexample, with reference to FIG. 4 , the arm 132 a that extends from thesecond transverse side 108 extends at least partially in an inwarddirection. The position and angle of each of the tabs 130 extending fromthe plate body 101 can depend on, for example, the anatomy of thepatient, the size and/or shape of the intramedullary nail 60, thelocation of corresponding apertures in the intramedullary nail 60, orother factors.

The head 134 of each tab 130 can define a tab aperture 136 that extendstherethrough. With reference to FIGS. 6A and 7 , the tab aperture 136 aextends through the head 134 from an upper opening 138 to a loweropening 140. Each of the upper and lower openings 138 and 140 can besubstantially perpendicular to a central aperture axis C_(A). Thecentral aperture axis C_(A) extends through a center of the tab aperture136 a. Alternatively, the upper and lower openings 138 and 140 can beangularly offset from a direction that is substantially perpendicular tothe central aperture axis C_(A). For example, the lower opening 140 canbe offset from the direction substantially perpendicular to the centralaperture axis C_(A) to align with an anatomy of the patient.

The bone-anchor aperture 136 a further includes an inner surface 142that extends about the central aperture axis C_(A). The inner surface142 can define at least one column 144. The at least one column 144 canextend about the central aperture axis C_(A) from the upper opening 138to the lower opening 140. Alternatively, the at least one column 144 mayextend about a portion of the inner surface 142. For example, the atleast one column 144 can extend from the lower opening 140 to a locationbetween the upper and lower openings 138 and 140. The at least onecolumn 144 can include threads. In an aspect, the threads of the atleast one column 144 can define variable-angle threading that permits abone anchor to be inserted into the bone-anchor aperture 136 a atvarying angles. Alternatively, the at least one column 144 of thebone-anchor aperture 136 a can be unthreaded.

The inner surface 142 can further define a receiving element 146. Thereceiving element 146 is configured to receive the bone plate adjustmenttool 200, as further described below. The inner surface 142 can define afirst cross-sectional dimension D₁ (e.g. radial dimension extending fromcentral aperture axis C_(A)), and the receiving element 146 can define asecond cross-sectional dimension D₂ (e.g. radial dimension extendingfrom central aperture axis C_(A)) that is greater than the firstcross-sectional dimension D₁. The receiving element 146 can comprise oneor more recesses that include curved, lobed, rectangular, and/or othershapes. For example, the receiving element 146 can include a single ormulti-lobe configuration, whereby each lobe of the receiving element 146is spaced radially outward from the first cross-sectional dimension D₁of the inner surface 142 relative to the central aperture axis C_(A).The number and spacing of the lobes of the receiving element 146 cancorrespond to a number and spacing of a connection element 202 of thebone plate adjustment tool 200.

The receiving element 146 can extend through the bone-anchor aperture136 a from the upper opening 138 to the lower opening 140.Alternatively, the receiving element 146 can extend partially throughthe bone-anchor aperture 136 a from the upper opening 138 to a locationon the inner surface 142 between the upper and lower openings 138 and140. The receiving element 146 is configured to receive the bone plateadjustment tool 200 through the upper opening 138 and into thebone-anchor aperture 136 a.

The receiving element 146 can be spaced circumferentially about theinner surface 142. For example, if the receiving element 146 includes 4lobes, each lobe can be spaced approximately 90 degrees apart from eachof the other lobes (e.g. cloverleaf configuration). Alternatively, eachlobe of the receiving element 146 can be spaced at varying degrees aboutthe inner surface, so long as the lobes correspond to the connectionelement 202 of the bone plate adjustment tool 200. The receiving element146 can also circumferentially intersect with the at least one column144 defined by the inner surface 142, forming peripheral areas of threadrelief arranged about the inner surface 142. For example, for areceiving element 146 including 4 lobes spaced 90 degrees apart, the atleast one column 144 can be positioned within the circumferential lengthof the 90 degrees between each lobe. In this example, the at least onecolumn 144 can include 4 sections spaced circumferentially about theinner surface 142 configured to receive and engage a bone-anchorpositioned within the bone-anchor aperture 136 a. If the at least onecolumn 144 includes a threaded section, the threaded section canthreadedly engage a corresponding threaded section of a bone-anchor.

Each of the bone-anchor apertures 136 defined by each tab 130 can beconfigured substantially similarly as each of the other bone-anchorapertures 136. For example, the bone-anchor apertures 136 defined by thetabs 130 extending from the first lateral side 110 of the plate body 101can have the same dimensions, threaded sections, receiving elements, orother features as the bone-anchor aperture 136 a defined by the tab 130extending from the second transverse side 108 of the plate body 101.Alternatively, each of the bone-anchor apertures 136 can be configureddifferently from one or more of the other bone-anchor apertures 136. Forexample, a cross sectional dimension (e.g. diameter and/orcircumference) of the bone-anchor aperture 136 a defined by the tab 130extending from the second transverse side 108 of the plate body 101 canbe greater than a cross sectional dimension of one or more of the tabapertures 136 defined by the tabs 130 extending from the first lateralside 110 of the plate body 101 and/or any of the other sides 106 and 112of the plate body 101. The particular configuration of the bone-anchoraperture 136 can correspond to the particular bone anchor being receivedwithin the aperture 136.

The at least one additional bone-anchor aperture 118 and the firstbone-anchor aperture 116 can be configured in a substantially similarmanner as the tab apertures 136 defined by the tabs 130. For example, atleast one or more of the additional bone-anchor apertures 118 and thefirst bone-anchor aperture 116 can include the receiving element 146 andthe at least one column 144. Each receiving element 146 of thebone-anchor apertures 116 and 118 can be configured to correspond to theconnection element 202 of the bone plate adjustment tool 200.

Each of the tabs 130 can be configured to flex and/or bend betweenmultiple positions. Each of the tabs 130 can transition between apre-fixation position, in which the head 134 a is in a first position,and a fixation position, in which the head 134 a is in a second positionspaced from the first position. The flexing of the tabs 130 is discussedfurther below with reference to FIG. 24 . The tabs 130 can comprise agrade of stainless steel or other material adapted to plasticallydeform. In an aspect, the tabs 130 can comprise a carburized stainlesssteel to avoid galvanic corrosion caused between the contact between thetab 130 and the bone-anchor 40 positioned within the bone-anchoraperture 136. For example, the intramedullary nail 60 can comprisetitanium or a titanium alloy due to its low elastic modulus thatencourages bone healing. If the bone-anchor 40 is made from either astainless steel or a titanium, there can be a risk of galvanic corrosionon one end of the anchor 40 or another, where disparate metals contacteach other. In an alternative aspect, the bone-anchor 40 can comprise acarburized stainless steel to avoid galvanic corrosion. It will beappreciated that other materials can be used to form the tabs 130, theplate body 101, and the anchors 40, including, for example, cobaltchrome, cobalt chrome alloys, or still other materials.

The arms 132 of each of the tabs 130 can include a substantially flatconfiguration. For example, each arm 132 can have a width that isgreater than a thickness of the arm 132. The flat configuration canfacilitate bending, and in particular, can facilitate bending in adesired direction. For example, the arm 132 can bend in directionssubstantially perpendicular to the width of the arm 132. The arm 132 canbe aligned with respect to the plate body 101 of the bone plate 100 suchthat the arm 132 can be bent to substantially align a contour of thebottom surface of the tab 130 with a contour of the surface of the bone70 of the patient during a surgical procedure.

Referring to FIG. 6B, the outer body surface 104 is spaced from theinner body surface 102 a first distance L₁ along the transversedirection T so as to define a plate body 101 thickness. The arm 132 adefines an inner arm surface 133 configured to face the underlying bone70. The arm 132 a further defines an outer arm surface 135 opposite theinner arm surface 133 along the transverse direction T. The outer armsurface 135 is spaced from the inner arm surface 133 by a seconddistance L₂ in the transverse direction T so as to define an arm 132 athickness. The first distance L₁ that defines the plate body 101thickness can be greater than the second distance L₂ that defines thearm 132 a thickness.

The inner arm surface 133 is spaced from the outer arm surface 135 in aninward direction I that is oriented along the transverse direction T. Inan aspect, the outer arm surface 135 is offset from the outer bodysurface 104 in the inward direction I. In an alternative or additionalaspect, the outer arm surface 135 is offset with respect to the outerhead surface 139 in the inward direction I. The inner arm surface 133can be continuous with the inner head surface 137. For example, theinner arm surface 133 may not be offset from the inner head surface 137in the inward direction I such that the inner arm surface 133 extendsadjacent to the inner head surface 137 without interruption.Alternatively, the inner arm surface 133 can be offset from the innerhead surface 137 in the inward direction I.

Referring to FIG. 7 , the arms 132 a can extend from the plate body 101to the head 134 along a central tab axis C_(T). Each arm 132 a can beconfigured to twist about the central axis C_(T) so as to move the head134 from the pre-fixation position to the fixation position. Each arm132 can include a first taper portion 129 and a second taper portion131. The first taper section 129 is located adjacent to the body 101.The outer arm surface 135 within the first taper section 129 can taperin an outward direction. The outward direction being opposite the inwarddirection I. The inner arm surface 133 within the first taper section129 can taper in the inward direction I. For example, the thickness ofthe arm 132 a within the first taper section 129 can be greater than athickness of the arm 132 along a length of the arm between the firsttaper section 129 and the second taper section 131.

The second taper section 131 is located adjacent to the head 134 a. Theouter arm surface 135 within the second taper section 131 can taper inan outward direction. The inner arm surface 133 within the second tapersection 131 can taper in the inward direction I. For example, thethickness of the arm 132 a within the second taper section 131 can begreater than a thickness of the arm 132 a along a length of the armbetween the first taper section 129 and the second taper section 131.

Alternatively, or additionally, a width of the arm 132 a within thefirst taper section 129 and the second taper section 131 can increasealong its length from the arm 132 a toward the body 101 and along itslength from the arm 132 a toward the head 134 a, respectively. The widthof the arm 132 a defining a dimension that is substantiallyperpendicular to the inward direction I and the length of the arm 132 abetween the first and second taper sections 129 and 131. The width ofthe arm 132 a within the first taper section 129 can be greater than awidth of the arm 132 a along its length between the first and secondtaper sections 129 and 131, and a width of the arm 132 a within thesecond taper section 131 can be greater than a width of the arm 132 aalong its length between the first and second taper sections 129 and131.

The head 134 a defines an inner head surface 137 configured to face theunderlying bone, and an outer head surface 139 opposite the inner headsurface 137. The outer head surface 139 is spaced from the inner headsurface 137 by a third distance L₃ so as to define a head 134 athickness. In an aspect, the third distance L₃ defining the head 134 athickness is substantially equal to the first distance L₁ defining theplate body 101 thickness. In another aspect, the third distance L₃defining the head 134 a thickness is substantially equal to the seconddistance L₂ that defines the arm 132 a thickness. In an aspect, thethicknesses of the arm 132 a, the head 134 a, and the plate body 101 canbe different.

Referring to FIGS. 8 and 9 , the bone plate adjustment tool 200 includesthe connection element 202, a shaft 204, and a handle 206. Theconnection element 202 is positioned at the distal end 201 of theadjustment tool 200. The shaft 204 extends between the connectionelement 202 and the handle 206. In an aspect, the connection element 202extends distally from a distal most end of the shaft 204. The handle 206extends from the shaft 204 toward a proximal end 203 of the adjustmenttool 200. The handle 206, the shaft 204, and the connection element 202can be rigidly connected together such that movement and/or rotation ofthe handle 206 causes movement and/or rotation of the connection element202. The bone plate adjustment tool 200 is configured to engage andtransition the tabs 130 from the pre-fixation position to the fixationposition.

The connection element 202 can comprise one or more protrusions 210 thatinclude curved, lobed, rectangular, and/or other shapes. For example,the connection element 202 can include a single or multi-lobeconfiguration, whereby each lobe (e.g. protrusion 210) of the connectionelement 202 protrudes in a radially outward direction. Each lobe of amulti-lobe configuration can be spaced circumferentially about a centerof the connection element 202. The number and spacing of the protrusions210 of the connection element 202 can correspond to a number and spacingof recesses of the receiving element 146 defined by the bone plate 100.

The connection element 202 is configured to engage the receiving element146 to at least temporarily connect the adjustment tool 200 to the boneplate 100. The connection between the adjustment tool 200 and the boneplate 100 can enable the adjustment tool to move and/or manipulate thebone plate 100. For example, the adjustment tool 200 can bend and/orflex the tabs 130. Additionally, the configurations of the receivingelement 146 and the connection element 202 can reduce the risk of damageto the inner surface 142 of the bone-anchor aperture 136. For example,if the inner surface 142 includes the at least one column 144 having athreaded region, the configurations of the receiving element 146 and theconnection element 202 can reduce the risk of thread damage.

It will be appreciated that more than one bone plate adjustment tools200 can connect with the bone plate 100. For example, a bone plate 100having more than one receiving element 146 that have differentconfigurations (e.g. size, shape, etc.), multiple bone plate adjustmenttools 200 can be used. In another example, a first bone plate adjustmenttool 200 can engage a first bone-anchor aperture 136 a, and a secondbone plate adjustment tool 200 can engage a second bone-anchor aperture136 a. The first bone plate adjustment tool 200 can used to, forexample, transition the tab 130 while the second bone plate adjustmenttool 200 provides, for example, a counter torque to maintain theposition of the bone plate 100. Each bone plate adjustment tool 200 cancomprise a a connection element 202 having a configuration (e.g. size,shape, etc.) that corresponds to a configuration of the respectivereceiving element 146.

FIGS. 10-13 illustrate an alternate aspect of a bone plate 300,according to aspects of this disclosure. Portions of the alternateaspect of the bone plate 300 disclosed in FIGS. 10-13 are similar toaspects of the bone plate 100 described above in FIGS. 2-7 and thoseportions function similarly to those described above. The bone plate 300includes a body 301 having a bone-facing surface 302 and an outersurface 304 opposite the bone-facing surface 302. The bone plate 300includes an outer side surface 303 that extends about an outer perimeterof the body 301.

The bone plate 300 defines a first bone-anchor aperture 316 that extendsthrough the bone plate 300 from the outer surface 304 to the bone-facingsurface 302 so as to receive the bone anchor 40 to attach the bone plate300 to the bone 70. The bone plate 300 defines at least one additionalbone-anchor aperture 318, such as a plurality of additional bone-anchorapertures 318. The at least one additional bone-anchor aperture 318 isspaced from the first bone-anchor aperture 316. The bone plate 300further includes at least one tab member 330.

The bone plate 300 further includes the fixation element 350. Thefixation element 350 extends at least partially through the outersurface 304 and includes a recessed portion 352, a first aperture 354,and a second aperture 356 (e.g. a plate fixation element). The fixationelement 350 is configured to receive a bone plate holder 400 within toconnect the bone plate 300 to the bone plate holder 400. The fixationelement 350 can include fewer or more apertures 354 and 356 to alignwith corresponding elements of the bone plate holder 400.

The recessed portion 352 extends into the body 301 from the outersurface 304 to an inner recessed surface 358. The first and secondapertures 354 and 356 both extend from the inner recessed surface 358into the body 301 toward the bone-facing surface 302. In an aspect, oneor both of the first and second apertures 354 and 356 extend through thebody 301 to the bone-facing surface 302. The first aperture 354 can bethreaded to receive a corresponding threaded portion of a plate couplingelement 432 of the bone plate holder 400. The threads defined by thefirst aperture 354 can extend along an entire length of the firstaperture 354. Alternatively, the threads can extend along a partiallength of the first aperture 354. For example, the threads can extendfrom the inner recessed surface 358 toward the bone-facing surface 302.

The second aperture 356 is spaced apart from the first aperture 354within the recessed portion 352. The second aperture 356 can beunthreaded and configured to receive a corresponding portion (e.g. aholder fixation element 422) of the bone plate holder 400. The secondaperture 356 can have a cylindrical shape, a conical shape, or othershape that corresponds to the holder fixation element 422 of the boneplate holder 400.

In an alternative aspect, one or both of the apertures 354 and 356 canbe positioned within the recessed portion 352. For example, one or bothof the apertures 354 and 356 can extend into the body 301 from the outersurface 304 toward the bone-facing surface 302.

The recessed portion 352 includes an inner edge 353 extending about aperimeter of the recessed portion 352. The inner edge 353 has a firstend 355 spaced from a second end 357 in a plate lateral direction L. Thesecond aperture 356 is positioned between the first aperture 354 and thefirst end 355 in the plate lateral direction L. The first aperture 354is positioned between the second end 357 and the second aperture 356 inthe lateral direction L. The inner edge 353 tapers in width, as measuredin a direction substantially perpendicular to the plate lateraldirection L, from a maximum width W₁ of the inner edge 353 locatedtoward the second end 357 to a minimum width W₂ located toward the firstend 355. A length between the maximum width W₁ and the minimum width W₂along the inner edge 353 can be substantially linear.

It will be appreciated that the fixation element 350 can includeadditional elements, for example, additional apertures, retentionselements, recesses/protrusions, or other elements. The fixation element350 can also include other fixation configurations to connect to thebone plate holder 400. For example, the fixation element 350 can includea snap-fit, friction-fit, or other type of fixation configuration.

FIGS. 14-20 illustrate the bone plate holder 400, according to aspectsof this disclosure. The bone plate holder 400 includes a body 402 (e.g.holder body), a shaft 404, and a grip member 406. The grip member 406 isconfigured to be gripped by a surgeon performing a surgical procedure toalign the bone plate holder 400 with the bone plate 100, and to controlthe position of the bone plate 100 while the bone plate 100 is beingfastened to the intramedullary nail 60. The grip member 406 can connectto a handle connection portion 403 of the body 402. The body 402 and theshaft 404 are configured to control connecting and disconnecting thebone plate holder 400 with the bone plate 100.

With reference to FIGS. 15 and 16 , the body 402 has an inner surface410 that extends through the body 402 from a proximal surface 411 at aproximal end 412 of the body 402 to a distal surface 413 at a distal end414 of the body 402. The proximal end 412 is spaced from the distal end414 in a proximal direction P. The inner surface 410 defines a shaftchannel 416 that extends along a central channel axis C_(S) through thebody 402 from the proximal end 412 to the distal end 414. The innersurface 410 further defines a shaft retention portion 418. The shaftretention portion 418 is located toward the proximal end 412 of the body402. The shaft retention portion 418 can include a locking feature 420to at least temporarily secure the shaft 404 within the shaft channel416. In an aspect, the locking feature 420 can include a threadedportion configured to engage with a corresponding body coupling element434 of the shaft 404.

The body 402 further includes the holder fixation element 422 (e.g. aprojection) configured to interface with the second aperture 356 of thebone plate 300. The holder fixation element 422 can extend distally fromthe distal surface 413. The holder fixation element 422 can have asubstantially cylindrical shape, conical shape, or other shape. Theshape and/or configuration of the holder fixation element 422 cancorrespond to a shape and/or configuration of the second aperture 356 ofthe bone plate 300. The interface between the holder fixation element422 and the second aperture 356 facilitates alignment of the bone plateholder 400 with the bone plate 300. It will be appreciated that the body402 can include multiple holder fixation elements 422, and the boneplate 300 can include multiple second apertures 356 that correspond tothe multiple holder fixation elements 422.

Referring to FIG. 17 , the distal surface 413 at the distal end 414 ofthe body 402 includes an outer edge 415 extending about a perimeter ofthe distal end 414. The outer edge 415 has a first end 417 spaced from asecond end 419 in a lateral holder direction L′. The fixation element422 is positioned between a distal opening 421 of the shaft channel 416defined by the distal surface 413 and the first end 417 in the lateralholder direction L′. The distal opening 421 is positioned between thesecond end 419 and the fixation element 422 in the lateral holderdirection L′. The outer edge 415 tapers in width, as measured in adirection substantially perpendicular to the lateral holder directionL′, from a maximum width W′₁ of the outer edge 415 located toward thesecond end 419 to a minimum width W′₂ located toward the first end 417.A length between the maximum width W′₁ and the minimum width W′₂ alongthe outer edge 415 can be substantially linear.

A configuration of the distal end 414 of the body 402 can be configuredto correspond to the recessed portion 352 of the fixation element 350 ofthe bone plate 300 so as to align the bone plate holder 400 with thebone plate 300 during connection of the holder 400 with the plate 300.For example, the distal end 414 of the body 402 can be received withinthe recessed portion 352 such that the plate lateral direction L alignswith the lateral holder direction L′ to at least partially rotationallylock the holder 400 with the plate 300 while the shaft 404 of the holder400 is being secured to the fixation element 350 of the plate 300. Themaximum width W′₂ and the minimum width W′₁ of the outer edge 415 of thebody 402 can be slightly less than the maximum width W₂ and the minimumwidth W₁ of the recessed portion 352, respectively, such that an outersurface 405 of the body 402 contacts an inner surface 351 of therecessed portion 352. The distal end 414 of the body 402 can be insertedinto the recessed portion 352 of the plate 300 such that the distalsurface 413 is substantially flush against the inner recessed surface358.

With reference to FIG. 18 , the shaft 404 includes a control element 430(e.g. a shaft grip member), the plate coupling element 432, and the bodycoupling element 434. The control element 430 is located at a proximalend 436 of the shaft 404. The plate coupling element 432 is located at adistal end 438 of the shaft 404. The body coupling element 434 islocated between the plate coupling element 432 and the control element430 along the shaft 404. The shaft 404 is configured to be inserted intothe shaft channel 416 of the body 402 through the proximal end 412. Thecontrol element 430 can be positioned externally to the shaft channel416, such that the control element 430 extends out of the proximalsurface 411 of the body 402 in the proximal direction P and isaccessible by a surgeon during a procedure. A distal surface of thecontrol element 430 can abut against the proximal surface 411 of thebody 402 when the shaft 404 is positioned within the shaft channel 416.

The plate coupling element 432 can extend through an opening defined bythe distal end 414 of the body 402, such that the plate coupling element432 extends distally out from the distal surface 413 of the body 402.

The body coupling element 434 is configured to engage with the lockingfeature 420 of the body 402. In an aspect, the body coupling element 434can include a threaded portion configured to engage with a correspondingthreaded portion of the locking feature 420. For example, duringinsertion of the shaft 404 into the shaft channel 416 of the body 402,the body coupling element 434 can engage the locking feature 420 untilthe body coupling element 434 is positioned distal to the lockingfeature 420. The position of the body coupling element 434 distal to thelocking feature 420 can provide at least a temporary lock between theshaft 404 and the body 402, such that the shaft 404 is at leastpartially restricted from exiting the shaft channel 416 through theproximal end 412 of the body 402. For example, when the locking feature420 and the body coupling element 434 are engaged and as the shaft 404is rotated in a first direction of rotation (e.g. a clockwisedirection), the body coupling element 434 moves distal to the lockingfeature 420 within the shaft retention portion 418. When the bodycoupling element 434 is in the position distal of the locking feature420 of the body 402, the shaft 404 is then rotatable in the firstdirection of rotation without translating relative to the body 402.

The plate coupling element 432 is configured to connect with the firstaperture 354 of the fixation element 350 of the bone plate 300. Theplate coupling element 432 can include a threaded portion 440 thatengages a corresponding threaded section of the first aperture 354. Theshaft 404 can be rotated by rotating the control element 430 relative tothe body 402 to threadedly connect the holder 400 to the bone plate 300.When the plate coupling element 432 is connected to the first aperture354, and the holder fixation element 422 is connected to the secondaperture 356, the bone plate holder 400 is rigidly received within theplate 300 such that linear and rotational movement between the holder400 and the plate 300 is substantially prevented. The rigid connectionbetween the holder 400 and the plate 300 allows the surgeon to controlthe movement and placement of the bone plate 300 relative to the bone 70of the patient during a surgical procedure.

After the plate 300 is secured to the bone 70, the bone plate holder 400can be removed from the bone plate 300. The shaft 404 can bedisconnected from the first aperture 354 by rotating the control element430 in a direction opposite to the direction of rotation for securingthe plate coupling element 432 to the first aperture 354. After theplate coupling element 432 is disconnected, the holder 400 can beremoved by retracting the distal end 414 of the body 402 from therecessed portion 352 and by retracting the holder fixation element 422from the second aperture 356.

The control element 430 can include an engagement element 442 thatdefines a hexagonal or any alternatively shaped structure that can beengaged by a screw driving instrument, a protrusion element engageableby a wrench, or a cross hole configured to receive a cylindrical bar torotate the control element 430 the bone plate holder 400 is beingconnected and disconnected to the plate 300.

With reference to FIGS. 21-26 , an example embodiment of a method ofimplanting an intramedullary nail 60 will be described. As shown in FIG.21 , the handle 90 is coupled to the intramedullary nail 60, and theintramedullary nail 60 is driven into the medullary canal of the bone 70by the handle 90. In FIG. 22 , the aiming guide 80 of the aimingassembly 50 is fastened to the handle 90. The bone plate 300 is fastenedto the bone plate holder 400 such that the bone plate 300 is configuredto angulate with the plate holder 400 to position the bone plate 300 onthe bone 70. Although reference is made below with respect to bone plate300, it will be appreciated that the description also applies to boneplate 100 and/or other bone plate configurations.

The patient can be oriented so that anatomic lateral shows condylaroverlap (e.g. perfect anatomic lateral), and the nail 60 can be rotatedto a desired position (e.g. obtain perfect circles). The nail 60 can belocked to the bone 70 (e.g. distal fragment) with a bone screw. In anaspect, the initial screw to lock the nail 60 to the bone 70 is a medialoblique screw. The screw substantially prevents motion of the nail 60relative to the bone 70.

With reference to FIG. 23 , an incision can be made and the bone plate300 is introduced to the bone 70. The incision can include, for example,an 8 cm incision to connect first and second lateral guide sleeves 92and 94. The first guide sleeve 92 can extend along the shaftlongitudinal axis A_(S1), and the second guide sleeve 94 can extendalong a second longitudinal axis A_(S2). The first guide sleeve 92aligns with the first bone-anchor aperture 316 and a first aperture inthe intramedullary nail 60, and the second guide sleeve 94 aligns withone of the additional bone-anchor apertures 318 and a second aperture inthe nail 60. A first drill bit (not shown) can be inserted into one ofthe first and second guide sleeves 92 and 94 to drill a first hole inthe bone 70. A second drill bit (not shown) can be inserted into theother of the first and second guide sleeves 92 and 94 to drill a secondhole in the bone 70. One of the first and second drill bits is removedfrom the bone, and a first bone-anchor screw (e.g. 5.0 VA locking screw)is inserted into the hole. The first bone-anchor can be positioned suchthat the bone-anchor is approximately 1 cm proud. After the firstbone-anchor has been inserted, a second bone-anchor screw (e.g. 5.0 VAlocking screw) is inserted into the other hole formed. The secondbone-anchor can be positioned such that the bone-anchor is approximately1 cm proud.

After the first and second bone-anchors have been inserted, a lateraloblique bone-anchor screw can be inserted. After the first and secondbone-anchors and the lateral oblique screw have been inserted, a lateralpressure can be applied to the plate 300 so the center and anteriorportions of the plate 300 fit to the bone 70. This can push one or moreof the tabs 330 off the bone 70. After the plate 300 is fit to the bone70, the first and second bone-anchors are tightened. The bone plateholder 400 can be removed from the plate 300 by rotating the controlelement 430 to release the plate coupling element 432 of the shaftholder 400 from the first aperture 354 of the bone plate 300. Theanterior locking screws can be inserted through the additionalbone-anchor apertures 318. In an aspect, holes can be pre-drilled in thebone prior to inserting the anterior locking screws.

With reference to FIG. 24 , the bone plate adjustment tool 200 canmanipulate each of the at least one tab members 330 so that theposterior portions of the plate 300 fit to the bone 70. For example, theconnection element 202 of the adjustment tool 200 is inserted into therespective aperture 336 of the tab 330, and a pressure (e.g. adeflection force) can be applied to the respective head 334 of the tab330 to cause the arm 332 to deflect the head 334 from the pre-fixationposition to the fixation position. For example, the arm 332 can deflectwith respect to the plate body 301 in response to a force so as to movethe head 334 between the pre-fixation position and the fixationposition. The force applied to the arm 332 to transition the headbetween the pre-fixation position and the fixation position can beinsufficient to cause the plate body 101 to deflect. After the head 334is transitioned to the fixation position, the inner head surface 137abuts the underlying bone. In an aspect, the arm 332 is deformable suchthat the fixation position of the head 334 is offset in the inwarddirection I with respect to the pre-fixation position of the head 334.

During transition, the trajectory of the screw through the respectiveaperture 336 should be considered to ensure the screw is securelylocated within the bone 70. After the tabs 330 have been transitioned totheir respective fixation position, posterior bone-anchor screws can beinserted through each aperture 336 and into the bone 70. After each ofthe bone-anchors has been inserted, a final torque can be applied to thebone-anchors.

Although the disclosure has been described in detail, it should beunderstood that various changes, substitutions, and alterations can bemade herein without departing from the spirit and scope of the inventionas defined by the appended claims. Additionally, any of the embodimentsdisclosed herein can incorporate features disclosed with respect to anyof the other embodiments disclosed herein. Moreover, the scope of thepresent disclosure is not intended to be limited to the particularembodiments described in the specification. As one of ordinary skill inthe art will readily appreciate from that processes, machines,manufacture, composition of matter, means, methods, or steps, presentlyexisting or later to be developed that perform substantially the samefunction or achieve substantially the same result as the correspondingembodiments described herein may be utilized according to the presentdisclosure.

What is claimed:
 1. A system comprising: a bone plate including: a platebody that defines a bone-facing body surface configured to face a boneand an outer body surface opposite the bone-facing body surface, whereinthe bone plate defines a plurality of threaded bone anchor aperturesthat extend through the plate body from the outer body surface to thebone-facing body surface and are each configured to receive a respectivebone anchor; and a plurality of tabs each including a flexible arm thatextends from the plate body, a head supported by the flexible arm, and atab aperture that extends through the head and is configured to receivea respective bone anchor; and an intramedullary nail configured to beinserted into medullary canal of the bone, wherein the intramedullarynail is configured to receive the bone anchors so as to fix theintramedullary nail to the plate body.
 2. The system of claim 1, whereineach of the threaded bone anchor apertures defines respective pairs witheach other of the threaded bone anchor apertures, and or each respectivepair of threaded bone anchor apertures, a straight line that extendsthrough respective centers of the bone anchor apertures of the pairdivides the plate body into a first side and a second side, and the tabextends from only one of the first and second sides, such that no tabsextend out from the other of the first and second sides.
 3. The systemof claim 1, wherein: the plate body defines a first direction, a seconddirection perpendicular to the first direction, and a third directionopposite the second direction and perpendicular to the first direction,the bone plate defines a bone plate aperture, the bone plate definesplurality of threaded bone anchor apertures that extend through theplate body and are each configured to receive a respective bone anchor,wherein the bone plate aperture is disposed between first and secondones of the threaded bone anchor apertures with respect to the firstdirection, such that a straight line that passes through the bone plateaperture and is oriented along the first direction also passes throughthe first and second ones of the threaded bone anchor apertures, and theplurality of threaded bone anchor apertures further includes third andfourth ones of the plurality of threaded bone anchor apertures that areoffset with respect to the hole in the second direction, such that asecond line that is oriented along the first direction and extendsthrough the third one of the plurality of fixation holes also passesthrough the fourth one of the plurality of fixation holes; and each ofthe heads is offset from the plate body in the third direction.
 4. Thesystem of claim 1, wherein the threaded bone anchor apertures comprisevariable angle threading.
 5. The system of claim 1, wherein each of thearms is flexible so as to align the tab apertures with theintramedullary nail.
 6. The system of claim 1, wherein the bone platefurther comprises a bone plate aperture that extends through the platebody that is configured to receive a corresponding fastener of a boneplate holder.
 7. The system of claim 5, wherein the bone plate apertureis threaded.
 8. The system of claim 7, further comprising a second boneplate aperture that is configured to receive a respective feature of thebone plate holder.
 9. The system of claim 8, wherein the second boneplate aperture is unthreaded.
 10. The system of claim 1, furthercomprising the bone plate holder.
 11. A bone plate including: a platebody that defines a bone-facing body surface configured to face a boneand an outer body surface opposite the bone-facing body surface, whereinthe bone plate defines a plurality of threaded bone anchor aperturesthat extend through the plate body from the outer body surface to thebone-facing body surface and are each configured to receive a respectivebone anchor, each of the threaded bone anchor apertures defining arespective pair with each other of the threaded bone anchor apertures;and a tab including an arm that extends from the plate body, a headsupported by the flexible arm, and a tab aperture that extends throughthe head and is configured to receive a bone anchor, wherein for eachrespective pair of threaded bone anchor apertures, a straight line thatextends through respective centers of the bone anchor apertures of thepair divides the plate body into a first side and a second side, and thetab extends from only one of the first and second sides, such that notabs extend out from the other of the first and second sides.
 12. Thebone plate of claim 11, wherein the tab comprises first and second tabs.13. The bone plate of claim 12, wherein the threaded bone anchorapertures and each tab aperture define variable angle threading.
 14. Thebone plate of claim 11, wherein the tab includes only the tab apertureand no other apertures configured to receive a bone anchor.
 15. The boneplate of claim 11, wherein the threaded bone anchor apertures comprisedifferently sized apertures that extend through the bone plate body. 16.The bone plate of claim 11, wherein the arm of the tab is flexible. 17.The bone plate of claim 11, further comprising an aperture having aperimeter defined by a first end, a second end opposite the first end,and an inner edge that extends from the first end to the second end,wherein the inner edge tapers in width from a maximum width of the inneredge located adjacent the second end to a minimum width located adjacentthe first end.
 18. The bone plate of claim 17, wherein a length of theinner edge between the maximum width and the minimum width issubstantially linear.
 19. The bone plate of claim 18, wherein theaperture defines a through-hole that extends through the bone plate. 20.A system comprising the bone plate of claim 11 and an intramedullarynail having respective bone-anchor apertures configured to receive firstand second bone anchors that are threadedly mated to respective ones ofthe threaded bone-anchor apertures.